Individual
DONNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19727 W NARRAMORE RD, BUCKEYE, AZ 85326-4238
(765) 545-0986
Mailing address
19727 W NARRAMORE RD, BUCKEYE, AZ 85326-4238
(765) 545-0986
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
1736383
AZ
Other
Enumeration date
06/29/2009
Last updated
06/29/2009
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